Ovarian cancer: meta-analysis compares primary cytoreduction vs NACT

  • Bartels HC & al.
  • Gynecol Oncol
  • 23 Jul 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with advanced ovarian cancer, neoadjuvant chemotherapy followed by interval cytoreductive surgery (NACT+ICS) is associated with lower morbidity and mortality and higher complete cytoreduction rates vs primary cytoreductive surgery (PCS), but no survival advantage.

Why this matters

  • PCS remains standard of care in this setting.
  • NACT+ICS can be an acceptable alternative in select patients with comorbidities, high frailty, and increased tumor burden.

Study design

  • A meta-analysis of 17 studies including 3759 patients with advanced ovarian cancer who underwent PCS or NACT+ICS.
  • Funding: None.

Key results

  • Patients in the NACT+ICS vs PCS group had significantly less:
    • Operative time (mean difference [MD], −35 minutes; P=.01).
    • Intraoperative blood loss (MD, −382 mL; P<.001>
    • Average length of hospital stay (MD, −5.0 days; P=.002).
  • NACT+ICS was associated with significantly higher:
    • Optimal cytoreduction rates (71.3% vs 59.8%; OR, 1.9; P=.001).
    • Complete cytoreduction rates (44.4% vs 28.3%; OR, 2.2; P=.0001).
  • No difference was observed in OS (OR, 1.0; P=.76).
  • Patients in the PCS group showed significantly higher:
    • Clavien-Dindo grade ≥3 morbidity (21.2 % vs 8.8%; P<.0001>
    • 30-day mortality rate (OR, 6.1; P=.0008).
    • Bowel resection rate (23.5% vs 8.8%; OR, 3.2; P<.001>

Limitations

  • Heterogeneity across studies.
  • Lack of QoL data.

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